| 1 | 1 | | 2021S0161-1 03/05/21 |
|---|
| 2 | 2 | | By: Schwertner, Buckingham S.B. No. 1161 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to patient choice in the dispensing of |
|---|
| 8 | 8 | | clinician-administered drugs. |
|---|
| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 10 | 10 | | SECTION 1. Subchapter A, Chapter 1369, Insurance Code, is |
|---|
| 11 | 11 | | amended by adding Section 1369.0042 to read as follows: |
|---|
| 12 | 12 | | Sec. 1369.0042. PROHIBITION AGAINST LIMITING PATIENT |
|---|
| 13 | 13 | | CHOICE WITH CLINICIAN-ADMINISTERED DRUGS. (a) In this section: |
|---|
| 14 | 14 | | (1) "Administer" means to directly apply a drug to the |
|---|
| 15 | 15 | | body of a patient by injection, inhalation, ingestion, or any other |
|---|
| 16 | 16 | | means. |
|---|
| 17 | 17 | | (2) "Clinician-administered drug" means an outpatient |
|---|
| 18 | 18 | | prescription drug other than a vaccine that: |
|---|
| 19 | 19 | | (A) cannot reasonably be self-administered by |
|---|
| 20 | 20 | | the patient to whom the drug is prescribed or by an individual |
|---|
| 21 | 21 | | assisting the patient with the self-administration; and |
|---|
| 22 | 22 | | (B) is typically administered: |
|---|
| 23 | 23 | | (i) by a physician or other health care |
|---|
| 24 | 24 | | provider authorized under the laws of this state to administer the |
|---|
| 25 | 25 | | drug, including when acting under a physician's delegation and |
|---|
| 26 | 26 | | supervision; and |
|---|
| 27 | 27 | | (ii) in a physician's office, hospital |
|---|
| 28 | 28 | | outpatient infusion center, or other clinical setting. |
|---|
| 29 | 29 | | (3) "Physician" means an individual licensed to |
|---|
| 30 | 30 | | practice medicine in this state. |
|---|
| 31 | 31 | | (4) "Health care provider" means an individual who is |
|---|
| 32 | 32 | | licensed, certified, or otherwise authorized to provide health care |
|---|
| 33 | 33 | | services in this state. |
|---|
| 34 | 34 | | (b) An individual or group accident and health insurance |
|---|
| 35 | 35 | | policy, contract, or agreement governed by the laws of this state |
|---|
| 36 | 36 | | may not: |
|---|
| 37 | 37 | | (1) require clinician-administered drugs to be |
|---|
| 38 | 38 | | dispensed by a pharmacy selected by the health plan; |
|---|
| 39 | 39 | | (2) if a clinician-administered drug is otherwise |
|---|
| 40 | 40 | | covered, limit or exclude coverage for such drugs when not |
|---|
| 41 | 41 | | dispensed by a pharmacy selected by the health plan; |
|---|
| 42 | 42 | | (3) reimburse at a lesser amount |
|---|
| 43 | 43 | | clinician-administered drugs dispensed by a pharmacy not selected |
|---|
| 44 | 44 | | by the health plan; or |
|---|
| 45 | 45 | | (4) require that an enrollee covered under such a |
|---|
| 46 | 46 | | policy, contract, or agreement pay an additional fee, higher copay, |
|---|
| 47 | 47 | | higher coinsurance, second copay, second coinsurance, or any other |
|---|
| 48 | 48 | | form of price increase for clinician-administered drugs when not |
|---|
| 49 | 49 | | dispensed by a pharmacy selected by the health plan. |
|---|
| 50 | 50 | | (c) Nothing in this section may be construed as: |
|---|
| 51 | 51 | | (1) authorizing a person to administer a drug when |
|---|
| 52 | 52 | | otherwise prohibited under the laws of this state or federal law; or |
|---|
| 53 | 53 | | (2) modifying drug administration requirements under |
|---|
| 54 | 54 | | the laws of this state, including any requirements related to |
|---|
| 55 | 55 | | delegation and supervision of drug administration. |
|---|
| 56 | 56 | | SECTION 2. This Act takes effect September 1, 2021. |
|---|